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Full text of "Assistance in the development of a system for the evaluation of the Executive and Medical Director positions"

Assistance in the Development of a System for the Evaluation of 
the Executive and Medical Director Positions 




March 13, 1980 

U.S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE 

HEALTH CARE FINANCING ADMINISTRATION 
MANUALS HEALTH STANDARDS AND QUALITY BUREAU 

RA 

399 
A3 

TA-20 
1980 



J 



J 



J 



.hi 




MEMORANDUM 



TO : Planning and Conditional PSROs 
Statewide Councils 
Regional PSRO Project Officers 



FROM Administrator 



DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

HEALTH CARE FINANCING ADMINISTRATION 
Office of the Administrator 

DATE: March 13, 1980 

Technical Assistance 
Document No. 20 



SUBJECT: Assistance in the Development of a System for the Evaluation of the 
Executive and Medical Director Positions 



The Health Standards and Quality Bureau (HSQB) contracted with Hay 
Associates to assist in the development of a system for evaluation of 
the Executive and Medical Director positions by the Board of Directors 
of the PSRO. 

Attached are the following documents developed by Hay Associates: 

1. PSRO Accountability Management (June 1978) 

2. Performance Planning and Measurement Worksheet (Executive and 
Medical Director) 

Since the documents are self-explanatory, it is not necessary to discuss 
them in detail in this memo. The material is provided as technical 
assistance for the development of a performance appraisal system which 
is a requirement of PSRO Transmittal No. 55. This is especially critical 
for the Executive and Medical Director positions, since any salary 
increase request must be documented with an appraisal of the individual. 
It is suggested that a system be implemented for the entire staff of 
your organization. This would assure equal consideration of all employees. 

I hope the attached material will be a useful tool and assist you in the 



management of your organization. 




Leonard D. Schaeffer 



Attachments 



PROFESSIONAL STANDARDS 
REVIEW ORGANIZATION 

ACCOUNTABILITY MANAGEMENT 
June 1978 



TABLE OF CONTENTS 



Pages 



INTRODUCTION 1 

BASIC CONCEPTS OF ACCOUNTABILITY MANAGEMENT 2 

ACCOUNTABILITIES 4 

DETERMINING THE END RESULTS - ACCOUNTABILITIES 4 

ACCOUNTABILITY STATEMENTS 4 

PRIORITIES OF ACCOUNTABILITIES 7 

MEASURES OF ACCOUNTABILITIES 9 

MEASUREMENT FORMS 9 

OBJECTIVITY 10 

COMPLEXITY 10 

INNOVATION OR IMPROVEMENT 11 

MEASUREMENT OF "STAFF" ACCOUNTABILITIES 12 

STANDARDS OF ACCOMPLISHMENT 14 



TARGETS 16 

SETTING TARGETS 17 

SAMPLE SET OF TARGETS 17 

HOW DIFFICULT 18 

WHERE DO TARGETS COME FROM ? 18 

HOW TARGET SETTING GETS DONE 19 

HOW DETAILED 19 

PERFORMANCE EVALUATION 20 

WHAT IS AN APPRAISAL? 20 

THE PERFORMANCE APPRAISAL PROCESS 21 

THE APPRAISAL PROCESS 23 

THE PERFORMANCE REVIEW 25 

DEVELOPMENTAL NEEDS 26 




J 



INTRODUCTION 



HSQB has studied a variety of approaches to management of the 
individual Professional Standards Review Organizations and has con- 
cluded that use of a system based upon accountabilities or defined end 
results of PSRO positions offers the greatest probability of success. 
The principles and methods of such an approach are outlined in the 
following pages for your consideration. This booklet provides you with 
an introduction to the philosophy, and procedures of accountability manage- 
ment and functions as: 

• A reading assignment for completion prior to your 
meetings on Accountability Management; 

• A meeting notebook for use during the meetings; 

• A permanent reference to the basic facts and 
concepts of the process. 



What is Accountability Management? Broadly speaking, it is a manage- 
ment process --a process for communicating, for motivating, for creating 
the kind of situation in which each person's efforts and rewards are in tune 
with the Organization's- objectives. 

Implementation of this process, however, requires that all members of PSRO 
management understand and use the same rational framework for dealing 
with their subordinates. And so, Accountability Management is also a 
multi-stage, disciplined system for: 



Defining 
the ex- 
pected end 
results of 
jobs - -the 
accounta- 
bilities 



Determining 
the measures 
for each end 
result 



Establishing 
performance 
levels for. 
each mea- 
sure 



Setting 
goals for 
perform- 
ance at 
chos en 
levels 



Appraising 
and review- 
W ing perfor- 
mance against 
goals and set- 
ing new goals 



These are the elements of Accountability Management. In order to practice 
Accountability Management on the job you need to know all of these elements 
thoroughly. 

The experience of many of the most progressive organizations in this 
country has demonstrated that the use of a common system of manage- 
ment can directly and significantly improve operating effectiveness 
and organizational success. We believe that Accountability Management 
provides the PSRO with such a system. 



BASIC CONCEPTS OF ACCOUNTABILITY MANAGEMENT 



Every organization is designed to provide goods, services, or satisfactions 
to some group of potential users. In our case, for example, our services 
are designed to enhance the quality of medical care provided by hospitals 
affiliated with the PSRO. 

These services are supplied through the PSRO's use of its processes 
and its human resources, i.e., people. The effectiveness of the PSRO 
is determined by the management of its resources. It is most effective 
when all its resources are integrated toward the accomplishment of the 
same ultimate results. 



We can accomplish this one-directional movement- -and thereby maximize 
our effectiveness --by involving all levels of management in one logical 
system of: 

• Defining the end results - -accountabilities - -expected 
to be achieved from the doing of each job; 

• Determining how to measure each end result- -a 
quantification of just what attainment of the end 
results involves; 

• Establishing the levels of performance possible for 
each measure, for identification of the quality of 
performance; 

• Setting goals for job performance that are targeted 
at specific performance levels; 

• Appraising and reviewing past performance against 
goals and setting goals for future performance. 

Accountability Management is not an instant, "packaged" program. Nor is 
it an interesting "idea" that can be used now and again. As suggested before, 
^ i s a complete management process, not a secondary procedure or an 
isolated program attached to other programs. It requires commitment and 
it requires follow-up support to succeed. 

You will find that one of the most significant impact areas of Accountability 
Management is the utilization of human resources. For after all, people 
tend to work more effectively when they: 



-2- 



• Know what they are expected to do; 

• Define, with appropriate guidance, the means of 
accomplishing results; 

• Measure the degree of accomplishment; and, 

• Receive rewards based on measured performance. 



-3- 



DEFINING THE END RESULTS - ACCOUNTABILITIES 



Each managerial or supervisory job is answerable for certain actions and 
the consequences of those actions - -this is the job's accountability. We refer 
to the totality of those expected actions, or end results, as job accountabilities. 

When you start an organization, it is fairly easy to know what end results 
you expect from the proper performance of each job. However, as the 
organization grows you probably find both managers and subordinates 
losing track of the expected end results. 

Frequently people are aware of their daily duties or responsibilities without 
knowing "why" the things they do are necessary. In the beginning this 
lack of understanding probably does not make too much difference. 
Management worries about "why" and tells people 'what" to do and "how" 
to do it. However, the larger or more complex the organization, the 
more difficult it becomes for any one person to understand the end results 
to be produced by each step. The growth of the PSRO has already produced 
these complex interrelationships. 

This situation can be alleviated by implementing a management system 
which first clearly defines the PSRO's desired end results, and then specifies 
the end results, or accountabilities, for each job. Thus, specific job 
accountabilities can be integrated into the larger picture of the PSRO's end 
results because they deal with the nature of the job itself and not the job' s 
incumbent . Only after we understand the job and its accountabilities can 
we integrate the incumbent's personal end results into this whole. 

For each position or function there are certain accountabilities which can 
only be accomplished by the incumbent. However, there are others that 
can and should be accomplished by subordinates. In practice, it may be 
that several specific accountabilities for a subordinate are derived directly 
from one aspect of his manager's accountabilities. For instance, a manager 
may need certain records to accomplish particular end results. In that 
job, record-keeping may not be an end result for his/her position, but there 
is frequently a subordinate job for which the major purpose is maintaining 
timely and accurate records. 

ACCOUNTABILITY STATEMENTS 

In order to turn in the best possible performance for a job- -and, in order 
for a person to supervise another job most effectively- -the person and his/her 
manager must understand what is required in the job. And, what is required 
is a collection of the specific, major end results expected. 



Thus, an accountability states the WHAT of a job. . .not how to accomplish 
it. It states that a position requires, say, "operating within expense 
budgets". . .not how the individual filling the position does that. 

A full statement of an accountability for an office or administrative manager 
might'be, "Ensure the development and maintenance of an annual budget 
adequate to handle current organization needs". The end result is "an annual 
budget adequate to handle current organization needs". The action prefacing 
the end results -- "ensure the development and maintenance" -- puts it into 
perspective. From this we know what kind of action the job takes toward the 
end result and whether it is a direct or supporting action. 

A job's end results do not change unless the job itself is changed. An 
end result is timeless. Organizations will probably always need some kind 
of an operating budget. Note, however, that is does not define what is 
"adequate" (that may change as the organization grows in complexity). . . 
nor does it describe how to "develop and maintain" the financial structure 
(that will depend on staff size, area covered, workload, etc.) 

Sometimes it is helpful in understanding what something is_ if we under- 
stand clearly what it is not . An accountability is not a statement of 
small details of day-to-day operation. "Handling correspondence" or 
"Reviewing minutes of Board meetings" are not significant accountability 
statements. These merely describe some of the "how" of the job. . .not 
the "what. " 

On the other hand, an accountability statement is not worth much if it 
is so broad and vague that it is difficult to measure performance against 
it. "Maximize income and minimize costs" or "Manage the Department 
effectively" are not good accountability statements. Each is vague and 
does not relate to something measurable. 

In the final analysis, statements of accountability should be statements 
of end results which any person in a management position (regardless of 
wh ether or not the incumbent is known) would expect any person in the 
position to produce . 

For managerial jobs the focus of accountabilities is on the elements of 
management, which include organization, staffing, motivation and 
development, planning and policy-making, direction of others, co- 
ordination, evaluation and control. These managerial actions relate to 
the end results for the PSRO's effective operation and growth (improved 
care, lower costs) 



-5- 



The most logical process for developing specific accountabilities is 
to look at the various components of a particular job (planning, 
organizing, directing, executing, evaluating, etc.) and consider how 
the job impacts on these areas and what result is desired by the 
impact. 

Accountabilities can be written in a basic format. One such format 
that helps clarify the nature of accountability statements includes: 

1. A "function" upon or against which action 
is taken; and, 

2. The "end result" or that which is to be 
accomplished by action on the function. 

An example of such a specific accountability statement is: 

"Supervision of case reviews to identify 
excessive hospital stays. " 

Broken down into its basic components, it may be viewed as: 

FUNCTION : Supervision of case reviews 

END RESULT: Identify excessive hospital stays 

This format should not be viewed as an ironclad formula for writing 
acceptable accountability statements. There is no guarantee that you will 
have defined an actual accountability simply because it is in this form. 
However, when you first begin to develop accountability statements it 
will be beneficial to organize your thinking in this or some similar manner 

Here's an example of another accountability: 

"Maintenance of a trained staff through continuous 
development of review personnel. " 

Statements prepared in this format answer the question, "What is the end 
result for which the position is answerable?" In this format the end 
result appears at the beginning of the statement and the action verb is 
understood. 



This accountability might be stated in another format as: 

"Conduct continuous training of review personnel 
to assure a competent staff. 



ACTION VERB: Conduct 
FUNCTION : Continuous training 



END RESULT : A competent staff. 

Now, what's so different about accountability statements and statements 
of "job responsibilities?" Simply this: accountabilities for a job delineate 
the minimum number of key end results which must be achieved for the 
job to be done. As stated earlier, they are the "what" of the job. Job 
responsibilities, on the other hand, are statements of how to get the job 
done. They are "duty statements" rather than statements of end results. 

PRIORITIES OF ACCOUNTABILITIES 

If we review the accountabilities for a position it appears that not all 
accountabilities have "equal weight" in terms of accomplishing the total 
job. There is little question that some accountabilities are more critical 
to the job than others - -albeit all are important to some degree. The 
problem, of course, is what are the relative importances or priorities 
of the accountabilities and what are the degrees of differences? 

One way to look at the question of "relative importance" is to ask yourself 
"In which of these accountabilities will below standard performance hurt 
the most?" Most managers would agree that one of the critical accounta- 
bilities is "Achieve speed and accuracy objectives. " This is an easy one. 
How about "Develop and motivate key subordinates to meet current perfor- 
mance objectives? 11 It is not the purpose here to determine what these 
relative importances are. That is the job for the person and his/her mana- 
ger to determine in discussions,, 

Assigning priorities to accountabilities helps puts things into perspective, 
and that is an important enough reason to go through the process. But 
priorities are also useful in the appraisal and review stages which we 
discuss later. The performance in critical accountabilities is, naturally, 
most critical. . . so it would be given the greatest weight in an appraisal. 
Then would come second and probably third priority accountabilities. 



-7- 



The important thing to keep in mind- -here and in Performance Appraisal 
and Review- -is that these are ways of getting manager and subordinate 
to sit down together and discuss the job and performance in the job, 
rather than the person and his/her personality. 



MEASURES OF ACCOUNTABILITIES 



In any system of planning, an important element is a mechanism for reviewing 
the degree to which expected results are being achieved. For example, a 
budget is a plan for spending money over a period of time; by reviewing costs 
and expenses (dollars which were spent) against the budget (dollars planned to 
be spent), we have a check on action against the plan. 

Accountability Management is a planning system. By establishing measures 
of the accountabilities of each job, it is possible to review systematically 
the actual end results against those which were expected. 

There are four types of measures of accountabilities which can be used. 
In considering a particular accountability, it is necessary to ask which form 
of measurement is possible; but no matter what form the measurement takes, 
the basic question is the same, i. e. , How did performance compare to the planj 

With an understanding of what accountabilities should and should not be, and 
with an understanding that within a list of accountabilities each one is rela- 
tively more or less important than the others--the most important area 
concerning accountabilities can be discussed. 

What are the quantifiable measures for judging performance against account- 
abilities? 

MEASUREMENT FORMS 

The four kinds of measures are: 

1. General descriptions --it is possible for you to learn something about 
the weather from a statement such as "a clear, cloudless, crisp day" 
as opposed to "a cloudy, foggy, damp day." However, the information 
you get is not very accurate and is quite subjective, i. e. , depends very 
highly on who is seeing the day. 

2. Judgmental scales - -it is possible for a large number of people to 
agree to use the same set of ratings. For example, a scale of one to 
seven could be developed to measure weather conditions. One could 
be "rain is actually falling" and seven could be "there are no clouds 
visible in the sky. " Descriptions for two through six could also be de- 
veloped. This removes some subjectivity from the judging process, 
but still allows considerable difference in judgment, depending on the 
observer. This form of measurement is frequently overlooked by many 
management people. It is often thought to be too subjective. However, 
it can frequently be very revealing, e. g. , in one insurance company 
the Director of Research sent out a questionnaire to all other depart- 
ments asking them to rate: the value of research projects, how the 

-9- 



results were used, were the results understandable, etc. He/she was 
shocked to learn that most other departments found most of the research 
projects worthless. This brought about a comprehensive refocusing 
and reorganization of the Research Department. 

3. Ratios --some results are best measured in terms of the relationship 
of actual performance given or demonstrated to the number of times 
or opportunities that the same performance could have been demon- 
strated. This is not the absolute measure of an end result, but since 
it does involve actual counts, subjectivity is minimized. Examples 
of commonly used performance ratios are batting averages (hits per 
at bat) or lapse ratio. 

4. Raw data --the most reliable form of measurement is that in which the 
physical objects, occurrences, happenings, or events are the measures 
used. Examples are cases reviewed, records audited, games won 

and number of home runs. In many cases, we limit our observation 
to a period of time, but for our purposes a measure of cases reviewed 
per month is equal in reliability and value to a count which does not 
take time into account, e.g., career home runs. 

OBJECTIVITY 

In establishing measures of accountabilities, effort should be directed toward 
finding the least subjective indicator of accomplishment of each end result. 
In this way we assure the best chance that, regardless of who makes a judg- 
ment about performance, the judgment will be the same. 

In those cases where measurements must be more subjective, it is possible 
to increase accuracy by using either (1) more than one indicator or (2) more 
than one judge. Multiple indicators are more frequently used in business than 
multiple judges. As a rule of thumb, no more than four indicators should 
be used for any accountability, since greater numbers tend to create confusion 
concerning the performance of an accountability. 

COMPLEXITY 

Another way in which measurement of accountabilities must be considered 
is to note that end results vary in terms of complexity or the degree to which 
the method of performance is dictated by the end result to be achieved. If 
the method is completely specified, measurement by exception is usually 
most effective. That is, the most likely thing is that the end result will occur, 
and time and energy are conserved by considering only those times when the 
accountability was not accomplished. For example, if there is an accountability 
involving effective utilization of equipment, unscheduled down-time is a key 
measurement. 



-10- 



On the other hand, a highly complex accountability, such as the conception of 
an entirely new service, only achieves its end result over a long time period. 
In this case, review of progress is necessary and can best be undertaken 
through measuring the rate and relevance of activity. Between these extremes 
there are many end results which are somewhat complex and can be measured 
by the accomplishment of secondary results reviewed at established target 
dates. 

In general, measures of activity are less desirable than measures of results . 
Most organizations come to win ball games not just to play in them. 



INNOVATION OR IMPROVEMENT 

How should accountabilities involving innovation or improvement be mea sured? 
There are two general approaches to this issue; the choice between them 
varies with the total organizational climate, the nature of a particular unit 
and the preference of the individual manager. 

One can say that improvement or innovation is associated with each account- 
ability; and that while performance "above and beyond the call of duty" will 
affect judgments of performance level, it does not involve distinct account- 
ability statements. An example of this line of thinking is: 

The performance of a file clerk is competent if he/she files "x" 
folders per day with "y" percent errors. Performance is 
commendable if in addition to that work, he/she helps others 
with their work. Finally, performance is distinguished if on 
top of all this he/she trains others to improve their performance. 

On the other hand, it is possible to consider areas for significant improvement 
or innovation as distinct and separate accountabilities and establish levels of 
measurement for each result to arrive at performance levels. According 
to this system-- 



Basic Accountability Element 


Measurement 


Performance Level 


1. 


quantity of filing 


number of folders 


x/hr. = Competent 






per hour 


(x+a)/hr. = Commendable 


2. 


quality of filing 


number of errors 


e/f = Competent 






per no. of folders 


(e-a)/f = Commendable 


3. 


helping with overload 


number of days 


1 day/week = Competent 






per week 


3 days/week = Commendable 


4. 


training others 


number of occa- 








sions per month 








-11- 





The important consideration with regard to the issue of improvement is that 
consistent practices be adopted since the two approaches appear overall 
to have about equal merit. 

MEASUREMENT OF "STAFF" ACCOUNTABILITIES 

It is frequently found that "line" accountabilities are more readily measured 
than "staff" accountabilities. When we think of accountabilities which involve 
cases reviewed, or notices dispatched, ratio measurements or direct counts 
quickly come to mind. Key staff accountabilities, however, usually are end 
results which involve either providing a service such as information or prob- 
lem analysis, or a control such as quality assurance or audit of changing 
practices and procedures. 

In order to measure the accountabilities which have only a contributory impact 
on organizational objectives, a necessary part of our thinking is to avoid 
trying to measure the staff unit in terms of the measurements appropriate 
to the accountabilities with primary impact. For example, to measure the 
professional relations promotion function in terms of hospitals delegated, or 
to measure the personnel function in terms of salary costs is usually un- 
realistic. 

Instead, measurements for staff positions must deal with the end results 
which are to be accomplished by the staff unit. The vital question is-- 
"What is the output of this position? " 

If the staff accountability involves a service, some common measurements 
are: 

number of occasions on which schedules were missed; 
number of person-hours (or budget) spent per hospital area; 
number of proposals implemented per number of proposals made; 
quality of service as described or rated by hospital; 
number of complaints (or commendations) regarding service from 
hospitals; 

descriptions of kinds of service provided relative to kinds of service 
requested; 

audits of effectiveness of service, e.g., studies of audit effec- 
tiveness; 

descriptions or ratings of the relevance and pacing of activity on in- 
novative accountabilities, e.g., developed a participant research 
plan which received the approval of the PSRO Board. 

When the staff function is more one of control (a special kind of service 
to management), some different measurements become important. Some 
of these are: 

-12- 



descriptions or ratings of relevance and pacing of audit activities; 
number of occasions on which audit schedules were missed; 
number of per son-hour s (or budget) spent per assurance area; 
number of "exceptions" found by outside sources, e.g., hospital 

complaints re quality, or exceptions by outside auditor; 
description, rating, or outside audit of relevance of techniques; 
comparison of end results with prestated objectives, e.g., "zero 

defects" or "zero deficiencies", 
descriptions or ratings of relevance and pacing toward implementation 

of error- free systems. 

These lists are not intended to be comprehensive, but rather should suggest 
the kinds of measures which are frequently used. In all cases the measures 
used should relate to the specific accountabilities of a job, and the emphasis 
dictated by the environment in which it exists. The key to sound measure- 
ments is the question- -"Will these measurements show the degree to which 
required end results have been produced? " 



-13- 



STANDARDS OF ACCOMPLISHMENT 



Is it possible to set objectives only for competent performance or to include 
in objective setting the levels of measurement corresponding to all levels 
of performance? The added refinement is necessary in order to emphasize 
the ability of the individual to affect his/her own levels of reward. 

Standards of accomplishment tell us how well we're doing against our objective, 
using the measures already determined. A measure is the yardstick. A 
standard of accomplishment says "at the 18-inch mark performance is good. . 
at the 24-inch mark performance is excellent. . . etc. " 

A discussion of standards between a person and his/her manager comes into 
play in two important areas: 

When the two discuss the accountability measures for the job objec- 
tives. This prepares the way for the time they will be evaluating per- 
formance later on; both shall have, agreed how to "grade" the perfor- 
mance. In other words, during the Performance Review there will 
be no surprises. Both will know what was expected- -both will know 
what was accomplished- -both will know how this actual accomplishment 
stacked up against expectations. 

When the person and the manager actually evaluate past performance. 
The "standards" agreed upon by the two give guidelines for evaluating 
that performance. 

Thus, although their use is more important later on, setting them is impor- 
tant now. 

The person and the manager should have a clear understanding of what the stan 
dard is. The person should not think it is Example A or B if the manager thinks 
it should be Example C. 

For any objective, the accomplishment may range well above or below it. 
PSRO may identify five levels of performance. These can be used to define 
standards of accomplishment in terms of each objective. The purpose 
is to define ahead of time the relationship between various levels of accomp- 
lishment and the five zones of performance rating. 

Distinguished Accomplishment obviously far above what is 

required (the objective) and which relatively 
few incumbents would be expected to achieve. 



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Commendable 



Accomplishment clearly above what is required 
(the objective). This level is usually achieved 
only by highly competent, seasoned incumbents. 



Competent 



Accomplishment that clearly meets the objective 
in all respects. Most qualified incumbents 
should be able to attain this level. 



Fair 



Accomplishment falls short of fully meeting the 
objective, but the tolerance of error is accep- 
table. At this level, there is a demonstrable 
need for improvement. 



Marginal 



Accomplishment clearly does not meet the ob- 
jective and needs of the organization. 



-15- 



TARGETS 



Accountabilities and measures are rather static. They define the area and 
the yardstick, but they do not specify what will be accomplished and when. 
Goals do. They are necessary to "trigger" the desired action. 

Perhaps a few definitions of how we will use certain words will help at this 
time, since one of our purposes is to establish a common language for man- 
agers. 



GOALS These are statements of intent or desire, e.g. , 

"We will be the biggest and the best" or, on a 
personal level, "I am going to be the best 
auditor in the PSRO. " A goal expresses where 
you want to go without a plan and without a 
commitment on how and when it will be reached. 

TARGETS These are statements which specify that a 

certain condition will exist by a certain time, 
e.g. , "We will increase hospital participation 
by 10% by year-end. " In order to make a speci- 
fic statement like this, several steps leading up 
to it are prerequisites: analysis of previous 
conditions; assessment of external events; 
projection of available resources. With this 
thinking out of the way, it is possible to estab- 
lish a TARGET and a PLAN. 



PLANNING The process which develops a plan which, in 

turn, contains the steps necessary to get from 
the present to the target. 



Within the dynamics of running the PSRO, long-range goals, long-range 
targets and annual targets are established to set the sights and give 
direction to the total organization. Within this framework, it is possible 
to establish targets for each job that contributes directly or indirectly to 
the overall organization targets. Key job targets are established within 
a framework of make-or-break accountabilities and the PSRO's annual 
targets. 



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; PSRO 




Annual Job 


Targets 


> 


Targets 



Make -or -Break 
Accountabilities 



Other targets may be established for the general and supporting account- 
abilities. 



SETTING TARGETS 



A target is simply an objective which an individual will attempt to reach 
in a particular period of time. The TARGET is stated in terms of a 
specific measured level of performance of an accountability. TARGET 
SETTING is the process in which a superior and subordinate agree to the 
performance goals for the coming time period--one to two years in most 
managerial positions. Both people must agree. The manager knows what 
the targets of this area are, and he/she is required to integrate the functions 
under him into a cohesive whole. The individual must agree because he/she 
will work most effectively towards ends which he/she has participated in 
planning for and since his/her rewards will be based on accomplishment of 
the agreed-upon targets. 

SAMPLE SET OF TARGETS 



The following chart will illustrate the relationship of accountabilities, mea- 
surements and targets. 



EXECUTIVE DIRECTOR 



Accountability Area Measurement Target 

1. Conduct Concurrent Timeliness of Review Decrease delay 

Admission Certifica- to 2 days 

tion 

Completeness of Review Decrease data 

deficiencies to 
2 items 



2. Develop criteria for Timeliness Expedite by 2 

review of specified months 
medical care 



Completeness Survive tests of 

practicability and 
applicability 



Application procedures Development by 

stated date 

-17- 



Accountability Area 



Measurement 



Target 



3. Promote delegated 
review capability- 



Number of hospitals 
achieving full capa- 
bility versus total 



Periodic increase 
in qualified hospitals 



Number of hospitals 
achieving limited 
capability versus 
total 



HOW DIFFICULT 

As a rule of thumb, an individual should have about seven chances in ten 
of accomplishing the targets set in this context. This assures the or- 
ganization that the planning process is more than just a guess and yet provides 
a strong requirement for individual effort if the target is to be attained. 
However, this "rule" should not be applied too literally, since some indi- 
viduals are likely to be operating close to their capacities and should have 
nine chances in ten for success. Others must have the pressure of only a 
50-50 chance in order to work most effectively. 



Periodic increase 
in partially qualified 
hospitals 



WHERE DO TARGETS COME FROM? 



The accountabilities of a position and their measures are more or less 
fixed. It is, however, usual that, at a particular time, work toward im- 
provement in all accountability areas is hot possible or desirable. The 
target related to many accountability areas may well be to "maintain cur- 
rent level. " 

Ideas on which accountabilities are in need of effort come in three general 
ways : 

1. Those areas in which the subordinate is particularly interested, 
and he has ideas he would like to try or feels he can develop 
from. 

2. Those areas in which the manager believes that the subordinate 
should work or that are essential to the targets of the organ- 
izational unit. 



-18- 



3. Those areas which relate to PSRO-wide targets, op- 
portunities or problems, such as cost reduction, major new 
service areas, etc. 

A balanced emphasis among these areas is important for effective target 
setting. The manager who insists on imposing all targets on his sub- 
ordinates is as likely to have limited results as the manager who gives no 
direction at all. 

HOW TARGET SETTING GETS DONE 

The major technique in target setting is that manager and subordinate sit 
down together after individually thinking through ideas from their respective 
points of view and reach agreement on a desirable package of targets for 
the coming time period. Such conversations should quickly become part of 
a normal working pattern; and, in general, the relationship of the two people 
involved should not vary markedly from their relationship in most other 
work contexts. Only managers who operate at the extremes of directiveness 
or lack of direction will find that their styles of behavior are ineffective for 
target setting and may be forced to change certain usual action patterns 
or accept minimal impact of the objective setting process. 

HOW DETAILED 

In setting targets, the manager and subordinate should be very specific 
about measured levels to be attained. In general, however, best results 
will be obtained if more initiative is taken by the subordinate in defining 
methods of achieving targets. This should never be carried to the extreme 
that the manager withholds information which he/she has on effective methods 
or fails to give guidance regarding apparently misdirected efforts. Another 
extreme position is that of the manager who accepts every target uncrit- 
ically without attention to the plan for successful achievement. Whenever 
possible, opportunities to seek new or different methods from other organizations 
or other parts of the PSRO should be used. In all, the manager and sub- 
ordinates should be very clear about the targets and committed to their 
accomplishment. Both should recognize the actions which they will have to 
take to assure success. The person who must achieve a particular end result 
needs a better understanding of the methods he/she will use while his manager 
needs only sufficient grasp to be assured that appropriate action is probable. 

The degree to which a target can be judged as reasonable depends on the 
thoroughness of the planning that preceded it. The subordinate should be 
prepared to outline the plan he/she feels will lead to meeting the target. 
If he/she does not have a plan, the reasonableness of the target and chance 
of success should be questioned. 



PERFORMANCE EVALUATION 



To sum up what has been discussed so far about accountability management: 
accountabilities are the end results a job must achieve; measures are the 
tools for analyzing and discussing performance against accountabilities; 
standards are the means of specifying what level of performance is expected; 
and targets are the objectives to be reached within a specified time limit. 

If each accountability has agreed-upon measures and standards, both an 
individual and his/her manager can evaluate the individual's performance ob- 
jectively and constructively. Both have the same understanding of the results 
expected from the job. Both agree upon the measures to be used in evaluating 
the performance. Both agree upon the standards of performance which delin- 
eate what a competent performance is--and, wherever possible, what other 
levels of performance are. 

With this background, the evaluation of performance becomes a very objective 
activity. A person knows what is expected in terms of quantifiable measures. 
"When actual results are in- -the person knows exactly how he/she has performed. 
He/she doesn't have to wait to hear what the manager thinks. 

These elements of the Accountability Management process have been dis- 
cussed so far in terms of their components. We now need to put them into 
a working framework. 

Presuming that we have established accountabilities, measures, targets 

and standards for the current year, we can sit back and await the performance 

results. With results identified, we proceed. 

WHAT IS AN APPRAISAL? 

Performance evaluation is a two-part process: performance appraisal 
and performance review: 

Performance Appraisal - this is done separately by 
the manager and subordinate, as preparation for the 
performance review. It involves the evaluation of 
performance against accountabilities. 

Performance Review - this is done by the manager and 
subordinate together, and involves discussion and agree- 
ment on their appraisals of past performance against 
accountabilities, with assignment of a performance 
rating on the basis of performance levels (Competent, 
or Commendable, etc.). 

-20- 



THE PERFORMANCE APPRAISAL PROCESS 



In the past, most appraisals were made only by the manager- -and then 
the results were explamed to the incumbent in what was called a performance 
review. Most of these appraisals were heavily weighted with subjective 
factors -- the person's attitude, how long he or she had been with the com- 
pany, a general "feeling" about progress and personality "traits. 11 

But there are some assumptions that enter into Accountability Management's 
approach which must affect our own methods of appraisal: 

• No one knows better than the person himself or herself 
what his performance is. 

• Potentially the best judge of a person's perfor- 
mance is the person themself -- you of your 
performance, your men and women of theirs. 

• The best definition of the job's end results depends 

on the person in the job. . .the best performance levels 
depend on that person. . . .and the best evaluation of 
performance depends on the same person. 

• Given both the discipline and the opportunity that 
Accountability Management represents, the person 
in the job will set high standards for his/her own 
performance and will be better motivated to live 
up to them as a result. 

• Both the results ior PSRO and the rewards for the 
incumbent will increase when the person in the job 
is his/her own best judge. 

So, because of the discussion of accountabilities, and because the seasoned 
incumbent knows his own job the best, the incumbent is probably the best 
appraiser. However, the manager also makes his/her own independent ap- 
praisal so that during the discussion the two can compare their two perspec- 
tives (one from the" viewpoint of doing the job. . .the other from a viewpoint of 
more experience on how the job should be done, and also from a higher 
managerial viewpoint). 



-21- 



The appraisal process considers: 

performance against previously set targets plus performance of an 
unusual nature against any and all accountabilities --for the past six 
or twelve months. 

Note, that targets may be based upon a year's projection of anticipated 
or hoped for achievement, however, at least one interim review during the 
year is essential if: (a) The subordinate and superior are to assess "what 
has been achieved thus far" and (b) What steps can we now take to assure 
optimum achievement in light of the past six months? 

For example, performance against objectives may have been "Competent. " 
However, if performance against another accountability, for which no par- 
ticular target has been set, was "Distinguished" this should certainly be 
considered in evaluating overall performance. 

Thus, at least annually , every incumbent would evaluate his own 
performance and discuss it with his manager (comparing the manager's 
evaluation of the person's performance). The performance evaluated is most 
concerned with: 

• how well were the targets previously set met? What "rating" could 

be ascribed to the performance against each target "Commendable", 
"Distinguished", "Competent", etc. 

• what areas of performance, other than those for which targets were 

set, were significant to overall performance. That is, what performance 
occurred that might be rated "Commendable", "Distinguished", "Com- 
petent", etc. 

• what are realistic, attainable job targets within the next six to 
twelve months. 

• what development needs to occur to assure job targets will be met. 
The appraisal does not consider such factors as: 

• length of service 

• time in position 

• personality factors (other than those that directly affect performance 
against accountabilities) 



-22- 



performance other than for the intervening period 



• potential for advancement 

You will note that, although the evaluation occurs every twelve months, 

targets can (and should) be set for time periods specific to the nature of 

the task. Some targets may be completed in three months, one month, 

or eight months. If this is the case, achievements are measured cumulatively. 

As a matter of fact, the most professional managers use the process as a 
daily managerial practice. It becomes second nature to think of the manage- 
ment process in terms of accountabilities, measures, targets and standards. 

THE APPRAISAL PROCESS 

The Appraisal, then, is a process whereby past performance is evaluated 
AND future targets are set. When a person appraises his own performance 
alone--or when a manager appraises a subordinate's performance alone-- 
the steps in the process are: 

1. Review each accountability and the targets set for it. You will 
recall our earlier discussion of the problems with the way in which 
targets have often been set in the past -- they were "thought up" in 
regard to a rather vague understanding of what the overall performance 
had been. There was no particular discipline involved. Therefore, 

it is important to start out and review accountabilities and targets 
to start making this discipline work. This is a "refresher" step where 
you completely familiarize yourself with all aspects of the accountability. 
It is possible at this stage to come up with some new me3°" ,- es. If so, 
add them. 

2. List actual performance. Here you know quantifiable factors of per- 
formance that relate to previously established measures. 

3. Compare performance with targets and standards. Were targets 
reached? Why or why not? What other unusual areas of performance 
were there, compared to standards for the job? 

4. What would be a rating for the accomplishment against each target? 
Competent? Distinguished? 

5. Set new targets for performance. 

6. Assign an overall performance rating by scanning all individual ratings 
and relative importances. 



-23- 



DO NOT engage in mathematics to arrive at an overall rating. 
Even though there are categories such as Distinguished, Commendable, 
Competent, etc., and even though there are relative importances-- 1, 
2, and 3--the system is not designed for arithmetical game s -playing. 

The actual appraisal process (done by the person and the manager alone) 
can be accomplished using an appraisal form as shown on the following 
page. 



-24- 



THE PERFORMANCE REVIEW 



The Performance Review is the discussion that the person and his/her man- 
ager have, based on their individual appraisals of the person's past per- 
formance and future targets. The discussion should be an open com- 
munications process and can best be accomplished if the subordinate manager 
always gives his/her analysis and comments first . This keeps the manager 
from having other than "equal influence" in the process. For example, if the 
manager gives his/her analysis, rating, and objectives first, then: 

• if the person does not agree, he/she is less likely to say so. 

• if the person does agree, the words and analysis are not really his/her 
and his/her commitment is likely to be less. 

The process of the Performance Review itself, however, generally follows 
a rough framework: 

1. For the same reasons given in the discussion of one appraisal, each 
accountability is briefly reviewed- -its statement, measures, standards, 
past targets, past performance, performance rating, development 
objectives and new job targets. 

2. Performance evaluations for all accountabilities are summarized, 
and an overall rating is agreed upon. New targets, how they will 
be accomplished (the plan), standards and developmental needs are 
agreed upon. 

3. The subordinate manager has the agreed-upon results typed up (any 
changes in measurements or standards, past performance facts, past 
performance evaluation and new targets). He/she makes sure his/her 
manager receives a copy. 

A Performance Review should discuss only: (1) actual past performance 
over the specified period of time, (2) realistic, work-oriented targets 
to accomplish in the future, and (3) developmental needs to meet current 
job targets. That is, it should be a discussion of the person's work -- not 
traits. It is dangerous to attempt to discuss personal traits because the choic< 
of words too often becomes subjective. If the manager says an employee 
is "stubborn, " the person may think of himself /herself as "aggressive or ten- 
acious. 11 Such a discussion can only cause a defensive reaction on the part of 
the employee, and the communications climate will most likely become closed. 

If the employee and his manager both see that the subordinate manager's 
output was 2% below the target they had set, then that is something that 
can be discussed in real, rational terms. And, it is a discussion of the work- 
rather than of the person himself. 



-25.- 



In planning how to conduct these Performance Reviews, and how often to have 
them, the manager should keep three principles in mind: 

1. The subordinate has a right to know where improvement is 

expected of him- -from the manager's point of view- -and whether he/she 
is making progress in his/her manager's eyes, while he/she still has 
time to do something about it. 

2. Discussions of accountabilities and targets should not be "corrective 11 
sessions. They are open communications sessions based on accounta- 
bilities, targets, and actual performance. However, in day-to-day 
operations employees at any level in an organization need and expect oc- 
casional corrective guidance. The subordinate is much more likely 

to overcome these operational deficiencies successfully if his/her mana- 
ger lets him/her know about them immediately after they occur than if 
his/her manager saves them all for discussion once a year. This is not 
only a poor method of correction, but it also changes the climate of the 
target- setting discussion from an open exchange to one of directive 
supervision. 

3. The more the subordinate participates in setting his/her own targets for 
performance, the higher the sense of commitment to achieving the 
objectives will be. 

DEVELOPMENTAL NEEDS 

The first and foremost concern is to identify what, if anything, needs to be 
done to improve current job performance. This may be development to meet 
the Competent level or development to meet the Distinguished level. Here 
again, a "problem- solving" approach rather than "words of wisdom" from the 
superior is most successful. The incumbent should be guided into analyzing 
why performance did not meet the target and what can be done about it. 

Experience has shown that distinguishing as clearly as possible between 
the managerial processes of judging past performance and of coaching with 
regard to future performance (development) provides the best chance that 
objective evaluations will be made and that future results will be at a higher 
level. This is not to say that the developmental process occurs without 
awareness of past performance, but that a problem- solving approach to im- 
provement should be taken instead of focusing on whether the judgment was 
correct or not. Specifically, the question should not be, "Why is your rating 
fair? " but, "How can your rating become competent? " Development focuses 
on each accountability area, attempting to find patterns of individual strengths 
or limitations in Know-How, Problem Solving or Ability to Accept Accounta- 
bility which relate to demonstrated achievement. The new set of targets 
should provide for effective utilization of strengths, as well as possibilities 
for learning new ways to work with or improve upon limitations. 



-26- 



At the point that performance meets or exceeds the Competent standard 
consistently, assessment of developmental needs can shift from the current 
job to jobs of greater accountability (promotions). This entails an exploration 
of the incumbent's aspirations in terms of future job openings and the iden- 
tification of what the individual needs to do to become a fully qualified can- 
didate. Here the manager can take a more directive approach in defining 
what the requirements of the promotional job are but should rely on the pro- 
blem-solving approach to help the subordinate determine what needs to be 
done. 



PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



EXECUTIVE DIRECTOR 



flrrniikiTAD i i iticc 
MllUUN 1 AD 1 L 1 1 Ibo 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


1. Ensures a competent, motivated and 
developing PSRO staff to meet cur- 
rent and perceived requirements. 


a. 


Annual Turnover 


a. 


0-15% Distinguished 
15-30% Commendable 
30-^5% Competent 
A0-50% Fair 
50-100% Marginal 








b. 


Staff Training Conducted Job 
Related 


b. 


Dist.-AI 1 staff ful ly job 

and PSRO oriented 
Comm. -All staff fully job 

tra i ned 
Comp. -Sufficient staff 

job trained to meet 

needs 

Unac.-Less than sufficient 
staff fully t ra i nec 








c . 


PSRO-Related Training for 
Hospital Staff 


c . 


Di st .-At 1 staff ful 1 y job 
trained and PSRO 
or i ented 

Comm. -All staff fully job 
tra i ned 

Comp . -Suf f i c i ent staff 

fully job tra i ned 
to meet needs 

Unac.-Less than sufficient 
staff fully tra i ned 








d. 


Staff Development 


d. 


Dist.-All Development ob- 
ject i ves 

Comm.-Ach i evement of sub- 
stantial //objective; 

Comp. -Plan prepared with 
obj. staff concurs 

Fair -Plan prepared with- 
out clear objectives 

Marg.-No plan prepared 







PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



EXECUTIVE DIRECTOR 

ACCOUNTAB 1 L IT 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


1. (cont'd) 


e. 


Staff Communication of 
goals, programs, etc. 


PSRO 


e. 


Dist.-All staff fully in- 
formed with feedback 

Comm. -All staff fully in- 
formed 

Comp. -Staff usually in- 
formed 

Fair -Staff occasionally 
i nf ormed 

Marg. -Staff usually unin- 
formed 






2. Manages PSRO financial activities 
to achieve established objectives 
within approved internal and exter- 
nal budgets. 


a . 


Performance by Fiscal 


Quarter 


a . 


Dist.- 0-51 below annual 
budget 

Comm.- 5-10% below annual 
budget 

Comp. -10-15% below annual 
budget or 
1-5% above 

Fair -15-25% below or 5-10? 

above annual 
budget 

Marg. -More than 25% below 
or 10% above annual 
budget 








b. 


Achievement of fiscal 
t i ve s 


objec- 


b. 


Dist. -90-100% 
Comm. -80-90% 
Comp. -70-80% 
Fair -60-70% 
Marg.-Less than 60% 







PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



EXECUTIVE DIRECTOR 



ACCOUNTAB 1 L IT 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


2. (cont'd) 


c. Audit deficiencies and resolu- 
t i on 


c. Dist. -No deficiencies 

Comm. -Minor deficiencies 
completely resolved 

Comp .-Substant i ve deficien 
cies completely 
resol ved 

Fair -Substantive deficien- 
cies partially 
resol ved 

Unac . -Substant i ve deficien- 
cies not resolved 






3. Oversees performance of nondelegated 
reviews to identify variances from 
approved norms, criteria and stan- 
dards of patient care. 


a. Review coordinator accuracy - 
Error rate 

b. Timeliness of Reviews 

1) Admission Certification 

2) Continued Stay Review 

3) Medical Care Evaluation 
including Restudies 

4) Profile Development 


a. Dist.- 0-5% 
Comm.- 5-10% 
Comp. -10-15% 
Fair -15-20% 
Marg. -20-25% 

b. 1 )Comm.-2nd Working Day 

Acc. -3rd Working Day 
Unac.-Ath Working Day 

2) Acc. -Timely 
Unac.-Not Timely 

3) As necessary/appropriate 
h)As necessary/appropriate 







• • c 



• a r 



PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



ACCOUNTABILITIES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


Oversees the performance of health 
care delegated reviews to identify 
variances from approved norms, 
criteria and standards of health 
care . 


a. Conducts periodic monitoring 
of hospital review to assure 
compl i ance . 


a. Establishment of Monitoring 
Schedu 1 e 
Yes-Competent 
No -Unsatisfactory 

Degree of Fulfillment of 
Scheduled Monitoring 

Marg. Fair Comp. Comm. Dist. 
1 2 3 5 
Sometimes Generally Always 
Meets Meets Meets 
Schedule Schedule or 

Betters 
Schedul e 


< 




5. Provides the governing body with 
timely and complete information 
and recommendations concerning 
new or existing PSRO functions 
to facilitate sound policy and 
program guidance, as directed by 
the GB . 


a. Provides timely reports and 
recommendations to GB re: 
Delegat ion 

Workload and Staffing 

Relationships 
Committee Membership and 

Funct ioning 
Budget Performance Quarterly 
Review Progress and Findings 
Achievement of Objectives 


a.1)Meets scheduled report 
dates-Competent 

Marg. Fair Comp. Comm. Dist. 
12 3 4 5 
Sometimes Generally Always 
Meets Meets Meets 
Schedule Schedule or 

Betters 
Schedul e 

a.2)0verall quality of reports 
related to soundness, prac 
ticality and applicability 

Marg. Fair Comp. Comm. Dist. 
1 2 3 h 5 







EXECUTIVE DIRECTOR 



ACCOUNTAB 1 L 1 T 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


6. Ensures the development and main- 
tenance of knowledgeable and working 
relationships with governmental, 
agencies, health insurance carriers, 
health care institutions and other 
professional organizations. 


a. Degree of communications with: 

Area Governmental Agencies 
Health Insurance Carriers/ 

1 ntermed i ar i es 
Health Care Institutions 
Professional Associations 

b. Signed Memoranda of Understand- 
ing and other Agreements 


a. Comm. - Open 
Comp. - Partial 
Marg. - Limited 

b. Ratio of Memoranda of 
Understanding signed vs. 
required and desired 
number 






7. Ensures the acquisition of timely 
and accurate performance data for 
profile review and analysis. 


a. Effective Data Collection 

b. Effective management of DP con- 
tract - 

c. Quality of Reports Generated 


a. Dist.- No backlog 
Comm.-^ 30 days backlog 
Comp.- 30-60 days backlog 
Unac-^60 days backlog 

b. Comp. -Successful negotia- 

tion of contract 
Comp. -Contractor compliance 

c. Comp. -Meets requirements 

for peer review and 
management analysis 






8. Develops and maintains effective 
working relationships with admin- 
istrative staffs of Health Care 
1 nst i tut ions . 


a. Feedback, various forms 


a. Very Positive-Distinguished 
Pos i t i ve-Commendabl e 
Neutral -Competent 
Negative-Unsatisfactory 








PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



EXECUTIVE DIRECTOR 



ACCOUNTAB 1 L IT 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


1 FUTURE TARGETS 
DEVELOPMENT ACTION 


9. Ensures the reasonable unit cost 
of review in delegated hospitals. 


a. Timely negotiation 

b. Settlement on schedule 

c. Achievement of targeted unit 
costs. 


a. Comp. - By beginning of 

hosp i tal Med i care 
Cost Reporting 
Per iod 

b. Dist. - 100% on schedule 
Comm. - 90% on schedule 
Comp. - 80% on schedule 
Fair - 70% on schedule 
Marg. - 60% on schedule 

c. Dist. - y 6% below target 
Comm. - 1-5% below target 
Comp. - 0-5% above target 
Fair - 6-10%above target- 

Unsatis.- ^> 10%above target 

















PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



MEDICAL DIRECTOR 



ACCOUNTAB 1 L 1 T 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


1. Ensures the development and main- 
tenance of effective liaison with 
physicians and other PSRO-area 
health professionals and institu- 
tions to assure timely and adequate 
support of PSRO operations. 


a. Feedback from medical -staffs 
and other health professionals. 

b. Broad participation of health 
professionals and physicians 
in PSRO activity. 

c. Ratio of initiatives proposed 
by Medical Director to those 

i mp 1 emented . 


a. In (Very Pos i t i ve-D i st . 
general / Pos i t i ve-Comm. 

it is 1 Neutral -Comp . 

b. Distinguished 
Commendabl e 
Competent 

Fa i r 
Marg i nal 

c. Dist. - > 90% 
Comm. - 85-891 
Comp. - 80-841 
Fair - 75-79% 
Marg. - < 79% 






2. Ensures the development and recom- 
mendation of professional policies 
to the governing body to facilitate 
PSRO functioning. 


a. Timeliness of recommendations 

b. Appropriateness of recommenda- 
tions 

c. Responsiveness to the needs of 
the GB 


a. 1 
Marg. 

b. 1 
Marg . 

c. 1 
Marg . 


2 *3 k 5 
Comp. Dist. 

2 3^5 
Comp. Dist. 

2 3 4 5 
Comp. Dist. 






3. Assures the establishment and 
maintenance of norms, criteria 
and standards of patient care. 


a. Existence of current norms 

b. . Existence of appropriate 

criteria 

c. Existence of an established 
system to modify norms and 
cr i ter i a 

d. Ratio of norms, criteria and 
standards approved vs. number 
recommended by the Medical 

D i rector . 


a. Yes-Competent 

No -Unsatisfactory 

b. Yes-Competent 

No -Unsatisfactory 

c. Yes-Competent 

No -Unsatisfactory 

d. > 90% Distinguished 
70-89% Commendable 

( 70% Competent 







• • r 

PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



MEDICAL DIRECTOR 



ACCOUNTAB 1 L IT 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


k. Ensures the identification and 
development of training programs 
and linkages to existing medical 
education programs for practi- 
tioners and hospital staff. 


a. The on-going presence or plan 
for application of education 
and training programs inter- 
faced with review results. 


a. Exists or PI anned=Comp . 
Nonexi stent or Non-Pi anned= 

Unsat i sf actory 

b. Existing program meets 
regional needs-degree 

1 2 3 *t 5 
Marginally Fully Outstanding 






5. Provides professional medical 
advice and counsel to the PSRO 
Executive Director and staff in 
conduct of the review process to 
support timely and appropriate 
performance of the PSRO. 


a. Are the necessary medical 
committees functioning 
adequatel y? 

b. Are medical committees 1 activ- 
ities coordinated and inte- 
grated? 

c. Is the Medical Director 
available to respond with 
medical advice? 


a. Level of Functioning 

12 3^5 
Marg Comp Dist 

b. Level of Coordination 

and Integration 

12 3^5 
Marg Comp Dist 

c. Responsiveness to Needs 

for Advice 

12 3^5 
Dccasionally Usually Always 







PERFORMANCE PLANNING AND MEASUREMENT WORKSHEET 



MEDICAL DIRECTOR 



AC COUNTAB 1 L 1 T 1 ES 


MEASURES 


STANDARDS 


PERFORMANCE 


FUTURE TARGETS 
DEVELOPMENT ACTION 


6. Identifies significant variances 
from norms, criteria and standards 
and presents accurate analysis and 
interpretation to the appropriate 
peer review group. 


a. Existence of a system for 

identification, analysis, inter- 
pretation and follow-up of 
var i ances . 


a. Quality S Comprehensiveness 

of System 

1 2 3 4 5 
Marg. Good Outstan. 

b. Ratio of variances 
addressed to variances 
resol ved 

)> 301 Distinguished 
85-891 Commendable 
80-84% Competent 
75-79% Fair 
\ lo'o narg 1 na 1 






7. Ensures the conduct of profile 
analysis to assist in problem 
definition resolution and assess- 
ment of program effectiveness. 


a. Recommendations, based on 
profile analysis, made to 
appropriate peer review 
group . 


a. Quality of Recommendations 
Made 

12 3 4 5 
Marg. Comp. Dist. 






8. Provides issue analysis and policy 
recommendations to the GB related 
to the medical profession. 


a. Timeliness of recommendations 

b. Quality of recommendations 


a . Time 1 i ness of Recommendat ions 

12 3 4 5 
Marg. Comp. Outstan. 

b. Quality of Recommendations 

12 3 4 5 
Msrcj* Comp. Outstsn. 







J